National Health Service Act 1977 (Amendment)

I beg to move,
That leave be given to bring in a Bill to improve the availability of terminations of pregnancy within the National Health Service.
The House will not need to be reminded that the 1967 Abortion Act permits abortions to be performed legally if two doctors agree that the woman fulfils certain criteria laid down by the Act. The Act of itself did not put any specific duty on the NHS to perform abortions. This has produced hardship for many women, and in some cases later abortions than necessary.

The Lane committee was concerned about this, and in its 1974 report it pointed out that the National Health Service Act put a duty on the Secretary of State to
promote the establishment in England and Wales of a comprehensive Health Service designed to secure improvement in the physical and mental health of the people.
Lane concluded that within that wording the NHS
has a responsibility to provide for abortion.
The Lane committee went on to say:
Section 3(1) of the NHS Act 1946 requires the Secretaries of State to provide hospital and specialist services 'to such an extent as he considers necessary to meet all reasonable requirements.' The Committee's opinion is that as a matter of principle hospital and specialist services should be provided to such an extent that patients are not forced to seek therapeutic abortion in the private sector.
That was clear enough, but the situation is still the same in 1981.

My purpose in introducing this Bill is to make it a duty on health authorities to provide facilities for women in their areas—free, of course, as are other operations under the NHS. We are all, surely, agreed that abortion should performed as early as possible because that is the safest way, and the fact that the NHS has failed to meet the needs of women and now performs fewer than half of all abortions means that very many women cannot get an abortion early and some cannot get one at all.

It will be said that the number of abortions performed in the NHS has risen over the last 10 years, but the annual percentage declined substantially from 56 per cent. in 1971 to 46 per cent. in 1979 and 1980, whereas the proportion of abortions performed in the private commercial and charitable sector has continued to rise.

There were many attempts during the past onslaughts on the Abortion Act to restrict the charitable sector. The proper provision of facilities under the NHS would have markedly reduced the necessity for women to seek help privately.

NHS abortion provision varies widely, as many women outside this House know to their cost. In 1979 the NHS in Dudley performed only 6 per cent. of all abortions, Sandwell 7 per cent. and Kirklees 11 per cent.; while in Tyneside it performed 92 per cent., as it did in West Glamorgan; the figures in Gateshead was 93 per cent., and in North Devon 94 per cent.

The 1967 Act protects anyone who does not wish to participate in abortions under the conscience clause. Of course, this right must be defended, but it is indefensible that the NHS should not provide treatment for women who are legally entitled to treatment under the law.

Lack of NHS resources in general has comparatively little effect on the number of abortions. The major reason
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for the unequal facilities is the attitude of senior gynecologists and, to a lesser extent, of GPs and nurses. The consultant gynecologist can either withhold treatment because of a conscientious objection to abortion or interpret the Act very narrowly—in fact, to strictly medical grounds.

A report by the Policy Studies Institute published this year confirmed that GPs in some areas refer women straight to the private sector rather than attempt to refer them to an NHS hopital where they know that consultants in the area will probably refuse to perform the abortion.

Although the majority of GPs are helpful towards women, there is evidence that GPs holding conscientious objections do not tell women of their attitude and do not inform them that they can get help elsewhere. Some women are, therefore, faced with a blank refusal, and they think that they have no alternative but to proceed with the pregnancy.

The Lane committee found:
For 31 per cent, of…women who eventually had abortions substantial delay was taking place before abortion had been discussed or any decisions made. GPs hostile to abortion contribute to lengthening the time before referral to hospital, either by referring the woman to another GP or by forcing a woman to seek advice elsewhere.
Nurses and midwives can also make it difficult. In the West of Scotland, for example, women find it very difficult to obtain an NHS abortion because of their attitude. The Scotsman reported in June 1980 that at one hospital in Scotland nurses had united in their stand against abortion and en masse invoked the conscience clause. This induced midwives in a nearby maternity hospital to withdraw their assistance in abortion operations because of the increased number of deliveries. There are therefore virtually no NHS abortions in that area, and the chief medical officer expressed the fear that women would turn to back-street abortionists.

Women living in areas where it is difficult to obtain abortions face three options. They can travel to another area, but they must first find it. That causes serious delays which result in the pregnancy being terminated later than necessary. It also means that the areas to which they go find it difficult to cope with the increased number of abortion patients. Alternatively, they can go to a private commercial or charitable abortion clinic, but that means that they must pay for the abortion although they are entitled to it free under the National Health Service. Finally, they may continue with an unwanted pregnancy. They may be unable to afford the fees charged by the private sector, but an unwanted pregnancy can cause grave difficulties not only to the woman but to the rest of her family.

The Bill does not provide for abortion on demand or compel any person to perform or assist in a termination of pregnancy. It does nothing to change the 1967 Act. The decision whether an abortion should be performed remains firmly in the hands of two doctors and the conscience clause remains intact.

The Bill seeks to encourage the equal provision of NHS facilities in all parts of the country. There are at present two options open to areas which find it difficult to perform NHS abortions because of the attitude of doctors or nurses. One is to contract out to private clinics. Several AHAs are sidestepping anti-abortion consultants by arranging additional services on a contractual basis with one of the charitable or commercial clinics.

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The other is the establishment of NHS day care centres. This is the most sensible way round the problem and 15 areas have already adopted it. It benefits both patients and staff. Women receive sympathetic treatment early in pregnancy and the operation is less traumatic emotionally and physically. Only those who are willing to work closely on abortion are employed in such units. What is more, it has considerable advantages in these days of financial cuts because the cost of day care abortion is about a quarter of the cost of in-patient abortion.

The Royal Commission on the National Health Service, reporting in July 1979, said:
Equality of access to health services was one of the objectives we set out…and abortion is a conspicuous example of lack of such equality.
I hope that Members of the House will not let either their own prejudices or those of some outside organisations prevent them from looking at the serious disparities of the present situation in a sensible and humane way, and that they will give leave to introduce the Bill. If they do, it will bring relief to women all over the country.

The hon. Member for Barking (Miss Richardson) seeks to amend the National Health Service Act 1977 to ensure that more abortion facilities are made available. I shall not need to take more than a few moments of the House's time to say why this would be wrong.

The Act that the hon. Lady wishes to change is concerned with providing certain facilities. Those facilities are specifically mentioned. They are the care of sick people, dental care, opthalmic care, ambulance services and, perhaps more appositely in this connection, contraceptive services. Nowhere from start to finish does that Act mention abortion because, unlike all the services that it mentions, abortion is not supposed to be available to all comers.

When the House passed the Abortion Act 1967 it was made amply clear that abortion would be available only under certain defined conditions. Time and again, the sponsor and his supporters stressed that it would not mean abortion on demand. Indeed, I think that it would never have been passed had we not been assured that that was the case.

The sole reason for the discrepancies in abortion availability to which the hon. Lady refers is that some doctors operate the law as Parliament intended and will not carry out the operation unless they believe that there are good reasons for doing so, while others abort any woman who asks. That is the difference to which the hon. Lady draws attention. Some doctors consider the facts of the matter with very much more care than others.

For the hon. Lady's Bill to be given permission to proceed the 1967 Act would have to be scrapped and a new one introduced, which would be a straight abortion-on-demand Bill, because if people could not ask for abortion on demand there would be no point in what is being suggested today. Abortion is available for any woman in this country who needs the operation.

It would be quite wrong to pass the hon. Lady's Bill. It would give priority in health expenditure to abortion. Many very serious health conditions—kidney failure, mental health care, cancer and scores of others— have a
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far stronger claim for extra money. If the House were to assent to the proposal before us, even though we all knew that the measure could get no further in this Session, the House would be showing its willingness to give priority over all other vital medical needs in order to provide abortion in all areas to all comers. That cannot be right. I urge the House to vote against the Bill.

§Question put, pursuant to Standing Order No. 13 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business):—